1891127502 NPI number — IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION

Table of content: (NPI 1891127502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891127502 NPI number — IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IOWA PHYSICIANS CLINIC MEDICAL FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891127502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 717
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50303-0717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-471-9300
Provider Business Mailing Address Fax Number:
515-471-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8101 BIRCHWOOD CT
Provider Second Line Business Practice Location Address:
SUITE N
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50131-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-471-9300
Provider Business Practice Location Address Fax Number:
515-471-9320
Provider Enumeration Date:
08/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LAINE
Authorized Official First Name:
ERICK
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC VP/COO
Authorized Official Telephone Number:
515-471-9227

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RR0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366425274 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CI6362 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CJ3564 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CC6757 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CC6519 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: CC7716 . This is a "RR MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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